Phototherapy for Neonatal Unconjugated Hyperbilirubinemia

Examining Outcomes by Level of Care

Eric Herschel Fein, Scott Friedlander, Yang Lu, Youngju Pak, Rie Sakai-Bizmark, Lynne M. Smith, Caroline J Chantry, Paul J. Chung

Research output: Contribution to journalArticle

Abstract

OBJECTIVES: Newborns hospitalized with unconjugated hyperbilirubinemia without critical comorbidities may receive intensive phototherapy (IP) in non-ICU levels of care, such as a mother-newborn unit, or ICU levels of care. Our aim was to compare outcomes between each level. METHODS: Using hospital discharge data from 2005 to 2011 in New York's State Inpatient Database, we performed multivariate analyses to compare outcomes that included total cost of hospitalization, length of stay, 30-day readmission rate after IP, and the number of cases of death, exchange transfusion, and γ globulin infusion. We included term newborns treated with IP in their first 30 days of life and without diagnosis codes for other critical illnesses. Explanatory variables included level of care, sex, race, insurance type, presence or absence of hemolysis, hospital, volume of IP performed at each hospital, and year of hospitalization. RESULTS: Ninety-nine percent of IP was delivered in non-ICU levels of care. Incidence of major complications was rare (≤0.1%). After adjusting for confounders, ICU level of care was not associated with difference in length of stay (relative risk: 1.2; 95% confidence interval [CI]: 0.91 to 1.15) or 30-day readmission rate (odds ratio: 0.74; 95% CI: 0.50 to 1.09) but was associated with 1.51 (95% CI: 1.47 to 1.56) times higher costs. CONCLUSIONS: For otherwise healthy term newborns with jaundice requiring IP, most received treatment in a non-ICU level of care, and those in intensive care had no difference in outcomes but incurred higher costs. IP guideline authors may want to be more prescriptive about IP level of care to improve value.

Original languageEnglish (US)
Pages (from-to)115-120
Number of pages6
JournalHospital pediatrics
Volume9
Issue number2
DOIs
StatePublished - Feb 1 2019

Fingerprint

Neonatal Hyperbilirubinemia
Phototherapy
Newborn Infant
Confidence Intervals
Costs and Cost Analysis
Length of Stay
Hospitalization
Hyperbilirubinemia
Globulins
Critical Care
Hemolysis
Jaundice
Insurance
Critical Illness
Comorbidity
Inpatients
Multivariate Analysis
Odds Ratio
Mothers
Databases

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Pediatrics

Cite this

Fein, E. H., Friedlander, S., Lu, Y., Pak, Y., Sakai-Bizmark, R., Smith, L. M., ... Chung, P. J. (2019). Phototherapy for Neonatal Unconjugated Hyperbilirubinemia: Examining Outcomes by Level of Care. Hospital pediatrics, 9(2), 115-120. https://doi.org/10.1542/hpeds.2018-0136

Phototherapy for Neonatal Unconjugated Hyperbilirubinemia : Examining Outcomes by Level of Care. / Fein, Eric Herschel; Friedlander, Scott; Lu, Yang; Pak, Youngju; Sakai-Bizmark, Rie; Smith, Lynne M.; Chantry, Caroline J; Chung, Paul J.

In: Hospital pediatrics, Vol. 9, No. 2, 01.02.2019, p. 115-120.

Research output: Contribution to journalArticle

Fein, EH, Friedlander, S, Lu, Y, Pak, Y, Sakai-Bizmark, R, Smith, LM, Chantry, CJ & Chung, PJ 2019, 'Phototherapy for Neonatal Unconjugated Hyperbilirubinemia: Examining Outcomes by Level of Care', Hospital pediatrics, vol. 9, no. 2, pp. 115-120. https://doi.org/10.1542/hpeds.2018-0136
Fein, Eric Herschel ; Friedlander, Scott ; Lu, Yang ; Pak, Youngju ; Sakai-Bizmark, Rie ; Smith, Lynne M. ; Chantry, Caroline J ; Chung, Paul J. / Phototherapy for Neonatal Unconjugated Hyperbilirubinemia : Examining Outcomes by Level of Care. In: Hospital pediatrics. 2019 ; Vol. 9, No. 2. pp. 115-120.
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